A histochemical study to identify nodal micro-metastasis in oral squamous cell carcinoma

Abstract

Background: Cancer cells tend to shed from the original tumor site and spread to another part of the body, group together and form a small collection of secondary tumors known as micro-metastatic tumor cells, frequently to lymph nodes in a predictable pattern often unobserved with advanced imaging techniques, that it can only be visible under microscope. Head and neck oral squamous cell carcinoma (HNSCC) has a significant potential for creating such micro-metastasis with higher incidence compared to clinically detected macro-metastasis. Aim: The aim of the study is to detect micro-metastatic lymph node by tumor cells and evaluate an effective method by using routine hematoxylin and eosin stain, Modified Papanicolaou stain and Toluidine blue by serial sectioning. Materials and method: A total of 60 lymph nodes retrospectively obtained from 10 patients diagnosed with oral squamous cell carcinoma who had undergone radical neck dissection, (i.e., three lymph nodes from both of Level I, II for each case), which initially identified as nonmetastatic by routine Hematoxylin and Eosin stain, were subjected to serial sectioning and re-evaluated for detection of micrometastasis. Results: Out of all the sections analyzed only 3 sections in level I and 2 sections in level II stained by Modified Papanicolaou stain showed positivity. Only 4 sections in level I lymph node and 3 sections in level II stained by toluidine blue showed positivity in detecting micro-metastasis. Conclusion: The present study concluded that special stains both toluidine blue and modified Papanicolaou stain are definitely valuable and sensitive in detecting micro-metastasis over Hematoxylin and Eosin stain.

Pathogenesis and detection of micrometastasis in OSCC- An overview

“…7 There are certain special stains like Modified Papanicolaou stain and Toluidine blue that are readily available and can be used on serial sectioned lymph node sections to detect micrometastasis which are usually overlooked in single-section Hematoxylin and Eosin stain. 3 Thus, these special stains stain are certainly valuable and sensitive in detecting micrometastasis by serial sectioning technique. Detection of micrometastasis in OSCC patients especially after surgery is undoubtedly beneficial for the patient as aids in modifying the treatment protocol inclusive of both radiotherapy and chemotherapy.…”

“…Detection of micrometastasis in OSCC patients especially after surgery is undoubtedly beneficial for the patient as aids in modifying the treatment protocol inclusive of both radiotherapy and chemotherapy. 3…”

“…1 Oral cancer is the sixth most frequent cancer worldwide, with a high prevalence in South Asia with estimating about 1/4 th of cancers in males and 1/10 th of cancers in females in India. 2,3 Oral squamous cell carcinoma (OSCC) is considered to be one of the foremost cancers across the globe. Several studies have been conducted regarding the natural history, epidemiology, and clinicopathological classification of OSCC so far.…”

“…essential in survival, recurrence and treatment modality. 3 De Masceral et al(1992) defined micrometastasis as metastatic deposits which measured less than 0.5 mm in diameter. 9 The Union for International Cancer Control (UICC) has classified and staged the tumor deposits within the lymph nodes that proposed micrometastasis as metastasis occupying between 0.2mm to 0.2cm of the sectioned area.…”